Provider Demographics
NPI:1477761187
Name:SENTHILVEL, EGAMBARAM (MD)
Entity Type:Individual
Prefix:
First Name:EGAMBARAM
Middle Name:
Last Name:SENTHILVEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 909
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40201-0909
Mailing Address - Country:US
Mailing Address - Phone:502-588-2220
Mailing Address - Fax:502-588-2221
Practice Address - Street 1:9880 ANGIES WAY
Practice Address - Street 2:STE. 330
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40241-2852
Practice Address - Country:US
Practice Address - Phone:502-588-2220
Practice Address - Fax:502-588-2221
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2014-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY45090207Q00000X, 207QS1201X, 207QS1201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS1201XAllopathic & Osteopathic PhysiciansFamily MedicineSleep Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201073350Medicaid
KY7100211060Medicaid
KY7100211060Medicaid